Experience with laparoscopic splenectomy

Background/Purpose: The laparoscopic splenectomy (LS) often is adopted to t reat children affected by hematologic diseases. Many of the pitfalls of LS are related to the 2 steps - dissection and extraction. Although various me thods have been adopted, the conversion rate still is too high during the l earning curve period. The authors analyse their experience in 54 laparoscop ic splenectomies performed by their teams in 3 European countries. Methods: From 1995 to 1999, 54 children underwent laparoscopic splenectomy, 4 of whom also underwent a concomitant cholecystectomy. There were 29 girl s and 25 boys with ages ranging between 4 and 19 years (median, 8.1 years). All patients underwent an elective laparoscopic splenectomy: Thirty childr en had hereditary spherocytosis, 13 had an idiopathic thrombocytopenic purp ura, 10 were affected by a beta thalassemia, and 1 child had sickle cell di sease. Results: Mean operating time was 140 minutes (range, 100 to 250 minutes). H ospital stay ranged from 2 to 6 days (median, 3 days). In 7 patients the sp leen was removed through a 7-cm minilaparotomy; in another 46 cases the spl een was captured into an extraction bag, fragmented, and then removed throu gh the umbilical or left orifice. There was one conversion to open surgery because of a camera failure during the operation. Conclusions: On the basis of our experience we believe that the operating t ime of LS is still too long compared with open surgery, and the extraction phase still not simple enough. A perfect control of hemostasis is fundament al because severe complications can arise from even a slight bleeding episo de. It also is very important to search for and remove any accessory spleen s. In our series this occurred in 7 patients, one of whom had 3 accessory s pleens. The laparoscopic approach is today a good alternative to open splen ectomy. Copyright (C) 2001 by W.B. Saunders Company.